Interlocking intramedullary rod assembly for treating proximal tibial fractures

ABSTRACT

A novel interlocking intramedullary rod assembly which allows the surgeon to (i) secure a first bone fragment of a fractured bone (e.g., a distal bone fragment) to the interlocking intramedullary rod assembly in a fixed position, (ii) secure a second bone fragment of the fractured bone (e.g., a proximal bone fragment) to the interlocking intramedullary rod assembly in an adjustable manner, and (iii) thereafter selectively pivot the second bone fragment (e.g., the proximal bone fragment) relative to the first bone fragment (e.g., the distal bone fragment) so as to secure the two bone fragments in position relative to one another with the desired orientation.

FIELD OF THE INVENTION

This invention relates generally to an interlocking intramedullary rodassembly for treating fractures of a long bone, and more particularly toan interlocking intramedullary rod assembly for treating fractures ofthe tibia.

BACKGROUND OF THE INVENTION

Fractures of the tibia are traditionally treated with either (i) anintramedullary rod (sometimes referred to as an intramedullary nail)which is positioned in the intramedullary canal of the tibia, or (ii) aplate applied to the side of the tibia and fixed in place with screwsset into the tibia. The choice of using an intramedullary rod or a plateis generally based on the location and complexity of the fracture.

As noted above, the intramedullary rod is placed in the intramedullarycanal of the tibia and typically provides excellent mechanical stabilityfor the bone. Among other things, the intramedullary rod exhibits goodweight-sharing properties. However, the use of an intramedullary rodalso involves a more complex surgical procedure and higher cost.

Plates are generally simpler to deploy and less expensive thanintramedullary rods. However, it can sometimes be difficult to achieveproper support for the fracture site with plates upon the application ofweight.

Intramedullary rods have evolved over time.

The first generation of intramedullary rods essentially involvedinserting a solid rod down the intramedullary canal of the bone. Thistype of intramedullary rod is relatively primitive and only grosslyre-aligns the bone. The first generation of intramedullary rods does notcontrol motion at the fracture line in any specific plane.

The second generation of intramedullary rods saw the introduction of theso-called interlocking intramedullary rod. The interlockingintramedullary rod allows for compression of the bone at the fracturesite by allowing axial compression of the fracture. This axialcompression of the fracture is achieved through the use of lag screwswhich pass through the bone (e.g., in the medial-to-lateral direction,posterior-to-anterior direction, etc.), across the intramedullary rodand back into the bone.

However, with current interlocking intramedullary rods, the surgeoncannot easily adjust the disposition of one of the bone fragments (e.g.,the proximal bone fragment) relative to the other of the bone fragments(e.g., the distal bone fragment). This makes it challenging for thesurgeon to align the two bone fragments relative to one another in anoptimal manner. More particularly, with current interlockingintramedullary rods, the surgeon must first adjust the disposition ofone of the bone fragments (e.g., the proximal bone fragment) relative tothe other of the bone fragments (e.g., the distal bone fragment), thentemporarily hold the two bone fragments in the desired alignment whilethe interlocking intramedullary rod is inserted into the intramedullarycanal, and finally insert one or more lag screws through each of thebone fragments and through the interlocking intramedullary rod so as tosecure the bone fragments to the interlocking intramedullary rod. Asthis occurs, one of the bone fragments may become misaligned relative tothe other of the bone fragments, so that it is secured to theinterlocking intramedullary rod in a non-optimal manner.

In view of the foregoing, it is an object of the present invention toprovide a novel interlocking intramedullary rod assembly which allowsthe surgeon to (i) secure a first bone fragment of a fractured bone(e.g., a distal bone fragment) to the interlocking intramedullary rodassembly in a fixed position, (ii) secure a second bone fragment of thefractured bone (e.g., a proximal bone fragment) to the interlockingintramedullary rod assembly in an adjustable manner, and (iii)thereafter selectively pivot the second bone fragment (e.g., theproximal bone fragment) relative to the first bone fragment (e.g., thedistal bone fragment) so as to secure the two bone fragments in positionrelative to one another with the desired orientation and/or with thedesired degree of compression.

SUMMARY OF THE INVENTION

The present invention comprises the provision and use of a novelinterlocking intramedullary rod assembly which allows the surgeon to (i)secure a first bone fragment of a fractured bone (e.g., a distal bonefragment) to the interlocking intramedullary rod assembly in a fixedposition, (ii) secure a second bone fragment of the fractured bone(e.g., a proximal bone fragment) to the interlocking intramedullary rodassembly in an adjustable manner, and (iii) thereafter selectively pivotthe second bone fragment (e.g., the proximal bone fragment) relative tothe first bone fragment (e.g., the distal bone fragment) so as to securethe two bone fragments in position relative to one another with thedesired orientation and/or with the desired degree of compression.

In one preferred form of the present invention, there is provided aninterlocking intramedullary rod assembly for treating a fracture of abone, said interlocking intramedullary rod assembly comprising:

an intramedullary rod comprising a distal section, a proximal section,and a lumen opening on said proximal section;

a pivoting component pivotally disposed in said lumen of saidintramedullary rod, said pivoting component being selectively pivotablerelative to the longitudinal axis of said intramedullary rod;

an adjustment screw disposed in said proximal section of saidintramedullary rod;

a distal interlocking screw comprising a distal end and a proximal end;and

a proximal interlocking screw comprising a distal end and a proximalend;

wherein said distal section of said intramedullary rod comprises astatic distal seat for receiving said distal interlocking screw, andsaid proximal section of said intramedullary rod comprises a dynamicproximal seat for receiving said proximal interlocking screw;

wherein said static distal seat is configured to secure said distalinterlocking screw to said intramedullary rod such that said distalinterlocking screw cannot move relative to said intramedullary rod, andsaid dynamic proximal seat is configured to secure said proximalinterlocking screw to said intramedullary rod and to said pivotingcomponent such that said proximal interlocking screw can be selectivelypivoted relative to the longitudinal axis of said intramedullary rod byselectively pivoting said pivoting component; and

wherein rotation of said adjustment screw causes said pivoting componentto pivot relative to the longitudinal axis of said intramedullary rod,whereby to selectively pivot said proximal interlocking screw relativeto the longitudinal axis of said intramedullary rod.

In another preferred form of the present invention, there is provided amethod for treating a fracture in a bone, said method comprising:

providing an interlocking intramedullary rod assembly comprising:

-   -   an intramedullary rod comprising a distal section, a proximal        section, and a lumen opening on said proximal section;    -   a pivoting component pivotally disposed in said lumen of said        intramedullary rod, said pivoting component being selectively        pivotable relative to the longitudinal axis of said        intramedullary rod;    -   an adjustment screw disposed in said proximal section of said        intramedullary rod;    -   a distal interlocking screw comprising a distal end and a        proximal end; and    -   a proximal interlocking screw comprising a distal end and a        proximal end;    -   wherein said distal section of said intramedullary rod comprises        a static distal seat for receiving said distal interlocking        screw, and said proximal section of said intramedullary rod        comprises a dynamic proximal seat for receiving said proximal        interlocking screw;    -   wherein said static distal seat is configured to secure said        distal interlocking screw to said intramedullary rod such that        said distal interlocking screw cannot move relative to said        intramedullary rod, and said dynamic proximal seat is configured        to secure said proximal interlocking screw to said        intramedullary rod and to said pivoting component such that said        proximal interlocking screw can be selectively pivoted relative        to the longitudinal axis of said intramedullary rod by        selectively pivoting said pivoting component; and    -   wherein rotation of said adjustment screw causes said pivoting        component to pivot relative to the longitudinal axis of said        intramedullary rod, whereby to selectively pivot said proximal        interlocking screw relative to the longitudinal axis of said        intramedullary rod;

positioning said intramedullary rod in the intramedullary canal of thebone so that said distal section of said intramedullary rod resideswithin the shaft of the bone and said proximal section of saidintramedullary rod resides within a proximal portion of the bone;

inserting said distal interlocking screw through the bone, through saidstatic distal seat and back into the bone, and inserting said proximalinterlocking screw through the proximal portion of the bone, throughsaid dynamic proximal seat and back into the proximal portion of thebone; and

adjusting the disposition of said adjustment screw within the lumen ofsaid intramedullary rod so as to pivot the proximal portion of the bonerelative to the remainder of the bone, whereby to secure the proximalportion of the bone in position relative to the remainder of the bonewith the desired orientation and/or with the desired degree ofcompression.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIG. 1 is a schematic view showing a novel interlocking intramedullaryrod assembly formed in accordance with the present invention, with thenovel interlocking intramedullary rod assembly being disposed in afractured tibia, and with the interlocking intramedullary rod assemblyand the fractured tibia being shown prior to partial reduction of thefracture;

FIGS. 2-5 are schematic views showing further details of the novelinterlocking intramedullary rod assembly of FIG. 1;

FIG. 6 is a schematic view showing a pivoting component, an adjustmentscrew and a set screw of the novel interlocking intramedullary rodassembly of FIG. 1, with the pivoting component being pivotally disposedwithin a tube of the novel interlocking intramedullary rod assembly;

FIGS. 7-11 are schematic views showing further details of the pivotingcomponent, adjustment screw and set screw of FIG. 6;

FIGS. 12-14 are schematic views showing further details of the pivotingcomponent of FIGS. 6-11;

FIGS. 15 and 16 are schematic views showing further details of theadjustment screw of FIGS. 6-11;

FIG. 17 is a schematic view showing further detail of the set screw ofFIGS. 6-11;

FIGS. 18 and 19 are schematic views showing the novel interlockingintramedullary rod assembly of FIG. 1 disposed in the proximal tibiawith the interlocking intramedullary rod assembly spanning a fractureline, such that a distal bone fragment and a proximal bone fragment aremounted to the interlocking intramedullary rod assembly by lag screws;

FIGS. 20-23 are schematic views showing the novel interlockingintramedullary rod assembly of FIG. 1 disposed in the proximal tibiawith the interlocking intramedullary rod assembly spanning a fractureline, and with a driver being used to selectively pivot the proximalbone fragment relative to the distal bone fragment across the fractureline so as to reduce a fracture in the proximal tibia and so as to allowthe surgeon to precisely align the proximal bone fragment relative tothe distal bone fragment in order to facilitate healing of the fracture;and

FIG. 24 is a schematic view showing another configuration of the novelinterlocking intramedullary rod assembly of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention comprises the provision and use of a novelinterlocking intramedullary rod assembly which allows the surgeon to (i)secure a first bone fragment of a fractured bone (e.g., a distal bonefragment) to the interlocking intramedullary rod assembly in a fixedposition, (ii) secure a second bone fragment of the fractured bone(e.g., a proximal bone fragment) to the interlocking intramedullary rodassembly in an adjustable manner, and (iii) thereafter selectively pivotthe second bone fragment (e.g., the proximal bone fragment) relative tothe first bone fragment (e.g., the distal bone fragment) so as to securethe two bone fragments in position relative to one another with thedesired orientation and/or with the desired degree of compression.

Novel Interlocking Intramedullary Rod Assembly

Looking first at FIGS. 1-3, there is shown a novel interlockingintramedullary rod assembly 5 formed in accordance with the presentinvention. Novel interlocking intramedullary rod assembly 5 may be usedto secure two bone fragments of a tibia 6 (e.g., a distal bone fragment7 and a proximal bone fragment 8) across a fracture line 9. Novelinterlocking intramedullary rod assembly 5 generally comprises anintramedullary rod 10, one or more distal interlocking screws 15, one ormore proximal interlocking screws 20, and a pivoting component 25pivotally mounted within intramedullary rod 10 for engagement by one ormore proximal interlocking screws 20, as will hereinafter be discussedin greater detail.

Looking next at FIGS. 4-6, intramedullary rod 10 generally comprises atube 30 having a distal section 35, a proximal section 40, and a lumen45 extending therebetween and opening on the proximal end of tube 30. Inone preferred form of the present invention, lumen 45 comprises aninternal screw thread 46 formed along the inner surface of lumen 45,along proximal section 40 of tube 30, for receiving an adjustment screw50 and a set screw 55 as will hereinafter be discussed in greaterdetail.

Distal section 35 comprises at least one static distal seat 60 (FIG. 6)formed in distal section 35 of tube 30 for receiving a distalinterlocking screw 15 as the distal interlocking screw passes through afirst (e.g., lateral) portion of the distal bone fragment 7 and into asecond (e.g., medial) portion of the distal bone fragment 7, the atleast one static distal seat 60 comprising a round opening 65 on a first(e.g., lateral) side of tube 30 and a round opening 70 on a second(e.g., medial) side of tube 30, the round openings 65, 70 being disposedon an axis which extends substantially perpendicular to the longitudinalaxis of tube 30 and being sized so as to form a snug interference fitwith a distal interlocking screw 15 therein.

Proximal section 40 comprises at least one dynamic proximal seat 75(FIG. 6) formed in proximal section 40 of tube 30 for receiving aproximal interlocking screw 20 as the proximal interlocking screw passesthrough a first (e.g., anterolateral) portion of the proximal bonefragment and into a second (e.g., posteromedial) portion of the proximalbone fragment, the at least one dynamic proximal seat 75 comprising anoblong opening 80 on the first (e.g., anterolateral) side of tube 30 andan oblong opening 85 on the second (e.g., posteromedial) side of tube30, the oblong openings 80, 85 being disposed on an axis which extendssubstantially perpendicular to the longitudinal axis of the tube 30, theoblong openings 80, 85 being sized so as to form a loose interferencefit with a proximal interlocking screw 20 therein, and the oblongopenings 80, 85 being in alignment with openings formed in pivotingcomponent 25, as will hereinafter be discussed in greater detail.

Looking next at FIGS. 3-14, pivoting component 25 comprises a body 90and an adjuster 92. Body 90 is pivotally mounted within tube 30 ofintramedullary rod 10 (e.g., via pivot pins 93), and has a distal end95, a proximal end 100, and one or more round openings 105 passingthrough body 90, round openings 105 being aligned substantiallyperpendicular to the longitudinal axis of body 90 and in lateralalignment with oblong openings 80, 85 formed in tube 30 such that aproximal interlocking screw 20 may pass through an oblong opening 80 intube 30, through a round opening 105 and through an oblong opening 85 onthe opposite side of tube 30 (see FIG. 5). It should be appreciated thatpivoting component 25, a round opening 105 and a pair of laterallyaligned oblong openings 80, 85 in proximal section 40 of tube 30together constitute the dynamic proximal seat 75 discussed above.Importantly, a proximal interlocking screw 20 which is passed throughoblong opening 80, through round opening 105 and through another oblongopening 85 makes a snug interference fit with round opening 105 of body90 of pivoting component 25 and a loose interference fit with oblongopenings 80, 85 of proximal section 40 of tube 30, such that pivotingcomponent 25 can move proximal interlocking screw 20 (and hence proximalbone fragment 8) when pivoting component 25 pivots within tube 30 ofintramedullary rod 10, as will hereinafter be discussed in greaterdetail.

In one preferred form of the present invention, pivoting component 25 ispivotally mounted intermediate distal section 35 and proximal section 40of tube 30 (e.g., via pivot pins 93) such that pivoting component 25 canpivot within lumen 45 relative to the longitudinal axis of tube 30 on anaxis intermediate distal end 95 and proximal end 100 of body 90. In apreferred form of the present invention, pivoting component 25 comprisesa finger 110 at its proximal end and a tapered distal section 115 at itsdistal end (FIGS. 7-14).

Adjuster 92 links adjustment screw 50 to body 90 of pivoting component25, and comprises a pair of mounts 120 and a globular element 125.Mounts 120 pivotally connect to finger 110 of body 90, and globularelement 125 is slidably received within adjustment screw 50 which is, inturn, threadingly engaged in the threaded proximal portion 46 of tube30. The pivoting interaction of mounts 120 of adjuster 92 with finger110 of body 90 are configured to translate longitudinal movement ofadjustment screw 50 (which contacts globular element 125 of adjuster 92)into pivoting movement of finger 120 within tube 30, and hence pivotingmovement of body 90 of pivoting component 25 within tube 30.

Looking next at FIGS. 15 and 16, in one preferred form of the presentinvention, adjustment screw 50 comprises a threaded screw having acavity 127 for receiving globular element 125 therein and a hexaglobularopening 130 for selective engagement by a driver D (FIGS. 1-4 and18-20). Adjustment screw 50 is threadingly mounted within the threadedproximal portion 46 of tube 30 such that rotation of adjustment screw 50(i.e., via driver D) causes longitudinal movement of adjustment screw 50within tube 30, and hence pivoting movement of finger 120 within tube30, and hence pivoting movement of body 90 of pivoting component 25within tube 30. As a result, when one or more proximal interlockingscrew(s) 20 are disposed in dynamic proximal seat 75 (and hence disposedwithin the proximal bone fragment 8, tube 30 and body 90 of pivotingcomponent 25), longitudinal motion of adjustment screw 50 will causepivoting motion of body 90 of pivoting component 25 and hence pivotingmotion of proximal bone fragment 8 relative to distal bone fragment 7along the line of the fracture 9.

Looking next at FIG. 17, in one preferred form of the present invention,set screw 55 comprises a hexagonal opening 135 for engagement by adriver (e.g., driver D, or another driver). Set screw 55 is threadinglymounted within the threaded proximal portion of tube 30 such that theset screw can be advanced distally (i.e., by rotating the set screw). Inuse, when proximal bone fragment 8 has been selectively pivoted into thedesired position vis-à-vis distal bone fragment 7 (i.e., by rotatingadjustment screw 50, which in turn pivots pivoting component 25 andhence moves the at least one proximal interlocking screw 20), a driver(e.g., diver D, or another driver) may be used to advance set screw 55distally such that set screw 55 engages adjustment screw 50 and preventsfurther longitudinal movement of the adjustment screw. As a result, whenset screw 55 engages adjustment screw 50, adjuster 92 (and hencepivoting component 25) are locked in position, whereby to preventfurther pivoting of proximal bone fragment 8 relative to distal bonefragment 7.

Method of Treating a Tibial Fracture

In use, and looking now at FIGS. 18-23, novel interlockingintramedullary rod assembly 5 may be used to treat a fracture of thetibia in the following manner.

First, the surgeon creates an opening within the intramedullary canal ofthe tibia in order to receive intramedullary rod 10 of interlockingintramedullary rod assembly 5 (e.g., by reaming the intramedullary canalof the tibia). It should be noted that the portion of the intramedullarycanal which passes through proximal bone fragment 8 should be reamed toa larger degree than the portion of the intramedullary canal whichpasses through distal bone fragment 7, such that some movement ispermitted between proximal bone fragment 8 and intramedullary rod 10(i.e., as proximal bone fragment 8 pivots relative to intramedullary rod10). Alternatively, where the intramedullary canal is “spongy”, thereaming of the portion of the intramedullary canal passing throughproximal bone fragment 8 does not need to be larger than the diameter ofintramedullary rod 10 disposed in proximal bone fragment 8, inasmuch asthe “spongy” nature of the intramedullary canal permits proximal bonefragment 8 to pivot relative to intramedullary rod 10).

The surgeon then inserts intramedullary rod 10 (i.e., tube 30) into theopening formed in the bone.

Next, the surgeon drills one or more holes HD in distal bone fragment 7,the one or more holes HD passing through both the lateral and medialportions of the distal bone fragment 7 perpendicular to tube 30, witheach hole HD being aligned with a static distal seat 60 formed in thedistal section 35 of tube 30. The surgeon then passes a distalinterlocking screw 15 through a hole HD formed in the distal bonefragment and through a static distal seat 60. Note that distalinterlocking screw 15 forms a snug interference fit with tube 30,whereby to form a snug connection between distal bone fragment 7 andintramedullary rod 10.

Using an aimer/jig, the surgeon next drills one or more holes HP throughboth the lateral and medial portions of proximal bone fragment 8, theone or more holes HP being aligned substantially perpendicular to tube30, with each hole HP being aligned with a dynamic proximal seat 75. Thesurgeon then passes a proximal interlocking screw 20 through a hole HPformed in the proximal bone fragment and through a dynamic proximal seat75, such that the proximal interlocking screw 20 passes through a pairof oblong openings 80, 85 formed in tube 30 and through a round opening105 in body 90 of pivoting component 25. Note that proximal interlockingscrew 20 forms a loose fit with tube 30 and a snug interference fit withbody 90 of pivoting component 25, whereby to form an adjustableconnection between proximal bone fragment 8 and intramedullary rod 10.

At this point in the procedure, distal bone fragment 7 has been securedto intramedullary rod 10 and proximal bone fragment 8 has been securedto body 90 of pivoting component 25 (which is in turn pivotallyconnected to intramedullary rod 10), with tube 30 of intramedullary rod10 spanning fracture line 9 in the tibia.

Next, the surgeon uses a hexaglobular driver (e.g., driver D) toselectively rotate adjustment screw 50 within tube 30, whereby toselectively move adjustment screw 50 longitudinally within tube 30, andhence to selectively pivot body 90 of pivoting component 25 within tube30, and thereby selectively pivot proximal bone fragment 8 (which isconnected to pivoting component 25 via one or more proximal interlockingscrews 20). As a result, the surgeon can use a driver to longitudinallymove adjustment screw 50 within tube 30 and pivot body 90 of pivotingcomponent 25 within tube 30, thereby allowing the surgeon to selectivelyadjust the disposition of proximal bone fragment 8 relative thedisposition of distal bone fragment 7 at the fracture line 9. It shouldalso be appreciated that by allowing the surgeon to selectively adjustthe disposition of proximal bone fragment 7 about the proximal end ofintramedullary rod 10, the present invention not only allows the surgeonto manipulate the angular disposition of proximal bone fragment 8relative to distal bone fragment 7, but also allows the surgeon totailor the degree of angular compression established between proximalbone fragment 8 and distal bone fragment 7 at fracture line 9, e.g., bypivoting proximal bone fragment 8 relative to distal bone fragment 7 soas to apply a desired degree of angular compression to the medial sideof the bone, the lateral side of bone, etc. When the desired angle ofdisposition has been achieved, the surgeon removes the hexaglobulardriver and uses a hex driver (e.g., driver D or another driver) torotate set screw 55, whereby to lock adjustment screw 50 into position,whereby to lock pivoting component 25 into position, and hence to lockproximal bone fragment 8 relative to distal bone fragment 7.

For ease of illustration, novel interlocking intramedullary rod assembly5 has been shown in FIGS. 1-3 and 18-23 disposed in the proximal portionof a bone (e.g., the tibia), with intramedullary rod 10 having arelatively short length and distal interlocking screws 15 being disposedrelatively close to fracture line 9. However, it should be appreciatedthat in many applications (e.g., in long bones such as the tibia), itmay be desirable for intramedullary rod 10 to have a relatively longlength and for distal interlocking screws 15 to be set fairly far fromfracture line 9. See, for example, FIG. 24, which shows an interlockingintramedullary rod assembly 5 having a relatively long intramedullaryrod 10 and having distal interlocking screws 15 disposed relatively farfrom a fracture line 9.

In addition to the foregoing, although novel interlocking intramedullaryrod assembly 5 has been described and shown above as being inserted intoa bone in a proximal-to-distal manner, with the proximal bone fragmentbeing pivotable relative to the distal bone fragment, it should also beappreciated that, if desired, novel interlocking intramedullary rodassembly 5 may, alternatively, be inserted into the bone in adistal-to-proximal manner. When novel interlocking intramedullary rodassembly 5 is used in this manner, the distal bone fragment is pivotablerelative to the proximal bone fragment (where the terms “distal” and“proximal” relate the frame of reference of the patient's limb).

And it should also be appreciated that the present invention may be usedto facilitate healing of a fracture in substantially any bone where itis desirable to pivot one bone fragment relative to another bonefragment and fix the fragments in position to facilitate healing. By wayof example but not limitation, such bone could include the tibia, thefemur, the humerus, etc.

Modifications of the Preferred Embodiments

Although the present invention has been described herein with referenceto particular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is, therefore, to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention.

1.-9. (canceled)
 10. A method for treating a fracture in a bone, saidmethod comprising: providing an interlocking intramedullary rod assemblycomprising: an intramedullary rod comprising a distal section, aproximal section, and a lumen opening on said proximal section; apivoting component pivotally disposed in said lumen of saidintramedullary rod, said pivoting component being selectively pivotablerelative to the longitudinal axis of said intramedullary rod; anadjustment screw disposed in said proximal section of saidintramedullary rod; a distal interlocking screw comprising a distal endand a proximal end; and a proximal interlocking screw comprising adistal end and a proximal end; wherein said distal section of saidintramedullary rod comprises a static distal seat for receiving saiddistal interlocking screw, and said proximal section of saidintramedullary rod comprises a dynamic proximal seat for receiving saidproximal interlocking screw; wherein said static distal seat isconfigured to secure said distal interlocking screw to saidintramedullary rod such that said distal interlocking screw cannot moverelative to said intramedullary rod, and said dynamic proximal seat isconfigured to secure said proximal interlocking screw to saidintramedullary rod and to said pivoting component such that saidproximal interlocking screw can be selectively pivoted relative to thelongitudinal axis of said intramedullary rod by selectively pivotingsaid pivoting component; and wherein rotation of said adjustment screwcauses said pivoting component to pivot relative to the longitudinalaxis of said intramedullary rod, whereby to selectively pivot saidproximal interlocking screw relative to the longitudinal axis of saidintramedullary rod; positioning said intramedullary rod in theintramedullary canal of the bone so that said distal section of saidintramedullary rod resides within the shaft of the bone and saidproximal section of said intramedullary rod resides within a proximalportion of the bone; inserting said distal interlocking screw throughthe bone, through said static distal seat and back into the bone, andinserting said proximal interlocking screw through the proximal portionof the bone, through said dynamic proximal seat and back into theproximal portion of the bone; and adjusting the disposition of saidadjustment screw within the lumen of said intramedullary rod so as topivot the proximal portion of the bone relative to the remainder of thebone, whereby to secure the proximal portion of the bone in positionrelative to the remainder of the bone with the desired orientationand/or with the desired degree of compression.
 11. A method according toclaim 10 further comprising a set screw disposed is said proximalsection of said intramedullary rod, wherein rotation of said set screwprevents rotation of said adjustment screw, whereby to selectively locksaid pivoting component and said proximal interlocking screw inposition.
 12. A method according to claim 10 wherein said static distalseat comprises a first round opening and a second round opening.
 13. Amethod according to claim 12 wherein said first round opening isdisposed on a first side of said intramedullary rod and said secondround opening is disposed on a second side of said intramedullary rod.14. A method according to claim 13 wherein said first round opening isaligned with said second round opening along an axis which extendssubstantially perpendicular to the longitudinal axis of said distalsection of said intramedullary rod.
 15. A method according to claim 12wherein said distal interlocking screw comprises a shaft sized to make atight fit within said first round opening and said second round opening.16. A method according to claim 10 wherein said dynamic proximal seatcomprises a first oblong opening in said intramedullary rod, a secondoblong opening in said intramedullary rod, and a round hole in saidpivoting component.
 17. A method according to claim 16 wherein saidfirst oblong opening, said second oblong opening, and said round holeare disposed on an axis which extends substantially perpendicular to thelongitudinal axis of said intramedullary rod.
 18. A method according toclaim 17 wherein said proximal interlocking screw comprises a shaftsized to make a tight fit within said round hole of said pivotingcomponent and a loose fit with said first oblong opening and said secondoblong opening.